Provider Alert! First Quarter 2024 HCPCS
Date: May 2, 2024
Attention: All Providers
Effective Date: April 1, 2024
Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that Texas Medicaid & Healthcare Partnership (TMHP) implemented the first quarter 2024 Healthcare Common Procedure Coding System (HCPCS) additions, revisions, and discontinuations, which will be effective for dates of service on or after April 1, 2024.
How this impacts providers: The following drug procedure codes will be added as Medicaid benefits effective April 1, 2024:
First Quarter 2024 HCPCS Added Procedure Codes
| Clinician-Administered Drug (CAD) Procedure Codes | ||
| C9166 | C9167 | C9168 |
| J0177 | J0577 | J0578 |
| J0650 | J0651 | J0652 |
| J1010 | J1202 | J1203 |
| J1323 | J2277 | J2782 |
| J2919 | J3055 | J7165 |
| J7354 | J9073 | J9075 |
Reminder: The CAD procedure codes listed in the table above will be added as Medicaid benefits as of the Centers for Medicare & Medicaid Services (CMS) effective date, April 1, 2024. Claims will deny until a rate is implemented, but affected claims will be reprocessed back to the CMS effective date. The procedure codes will be payable at the April 1, 2024, published rate until the Texas Health and Human Services (HHSC) rate hearing is held as required by the Texas Administrative Code 355.201.
Providers may also refer to the following website for details related to rate hearings: https://pfd.hhs.texas.gov/rate-packets
The following procedure code will be added as a Healthy Texas Women (HTW) benefit:
| CAD Procedure Code |
| J7354 |
The following procedure codes will be added as HTW Plus benefits:
| CAD Procedure Codes | |
| J0577 | J0578 |
Effective April 1, 2024, the following procedure codes will be added as noncovered procedure codes for Texas Medicaid:
| CAD Procedure Codes | ||
| J0209 | J0589 | J1434 |
| J2801 | J3424 | J9074 |
| J9248 | J9249 | J9376 |
| Q5133 | Q5134 |
| Non-CAD Procedure Codes | ||
| A2026 | A4271 | A4438* |
| A4564* | A4593 | A4594 |
| A9293 | C9796 | C9797 |
| E0152 | E0468 | E0736* |
| E0738 | E0739 | E2104 |
| G0138* | H0051 | K1037 |
| L1320* | L5783 | L5841* |
| Q4305 | Q4306 | Q4307 |
| Q4308 | Q4309 | Q4310 |
| S4988 | S9002 |
Procedure codes noted with an asterisk in the table above will require a Texas Medicaid rate hearing.
New benefits that are adopted by Texas Medicaid must complete the rate hearing process to receive public comment on proposed Texas Medicaid reimbursement rates.
After the rate hearing, expenditures must be approved before the rates are adopted by Texas Medicaid. Providers will be notified in a future notification if a proposed reimbursement rate will change, or a procedure code will not be reimbursed because the expenditures are not approved.
Procedure code E2298 will be a benefit of Texas Medicaid and will not require a rate hearing.
Additional Benefit Information
Age limitations will apply for the following procedure codes:
| Procedure Codes | Client Age Limitation |
| E0736, J1202, J1203, J1323, J3055, J7165 | 18 years of age or older |
Procedure code A4438 will be limited to clients who are 18 years of age or older with a purchased device and claims history of a neuromuscular electrical stimulation or transcutaneous electrical nerve stimulation procedure within the last five years.
Procedure code E2298 will require prior authorization and be limited to one purchase per five years. Refer to the current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.17.15, “Power Seat Elevation System,” for additional information about prior authorization criteria.
Procedure code G0138 must be billed with procedure code J1203 on the same day by the same provider. Procedure code J1203 must be billed with procedure code J1202 on the same day by the same provider.
Procedure code J7354 will be restricted to diagnosis code B081 and limited to clients who are 2 years of age or older.
Procedure code L1320 will require prior authorization and be limited to clients who are birth through 20 years of age.
Refer to the current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.19.2, “Prior Authorization and Documentation Requirements,” for additional information about prior authorization criteria.
Procedure code L5841 will require prior authorization and be limited to clients who are birth through 20 years of age. Refer to the current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, subsection 2.2.20.2.1, “Lower-Limb Prostheses,” for additional information about prior authorization criteria.
Procedure code C9166 will be limited to clients who are 2 years of age or older and restricted to the following diagnosis codes:
| Diagnosis Codes | ||
| L400 | L401 | L402 |
| L403 | L404 | L405 |
| L4050 | L4051 | L4052 |
| L4053 | L4054 | L4059 |
| L408 | L409 | M0880 |
| M450 | M451 | M452 |
| M453 | M454 | M455 |
| M456 | M457 | M458 |
| M459 | M4680 | M4681 |
| M4682 | M4683 | M4684 |
| M4685 | M4686 | M4687 |
| M4688 | M4689 |
Procedure code C9168 will be limited to clients who are 18 years of age or older and restricted to the following diagnosis codes:
| Diagnosis Codes | ||
| K5100 | K51011 | K51012 |
| K51013 | K51014 | K51018 |
| K51019 | K5120 | K51211 |
| K51212 | K51213 | K51214 |
| K51218 | K51219 | K5130 |
| K51311 | K51312 | K51313 |
| K51314 | K51318 | K51319 |
| K5180 | K51811 | K51812 |
| K51813 | K51814 | K51818 |
| K51819 | K5190 | K51911 |
| K51912 | K51913 | K51914 |
| K51918 | K51919 |
First Quarter 2024 HCPCS Discontinued Procedure Codes
Effective April 1, 2024, CMS will discontinue the following procedure codes:
| Discontinued Procedure Codes | Direct Replacement Procedure Codes |
| C9159 | J7165 |
| C9160 | J0589 |
| C9161 | J0177 |
| C9162 | J2782 |
| C9163 | J3055 |
| C9164 | J7354 |
| C9165 | J1323 |
| E2300 | E2298 |
| J0576 | J0577, J0578 |
| J1020 | J1010 |
| J2920 | J2919 |
| J9070 | J9075 |
| Discontinued Procedure Codes with No Direct Replacement | ||
| 0354U | 0416U | J1030 |
| J1040 | J1840 | J1850 |
| J2930 | J9250 | Q4244 |
Discontinued procedure codes will not be reimbursed after March 31, 2024.
First Quarter 2024 HCPCS Revised Procedure Codes
The description of the following procedure codes will be revised:
| Procedure Codes | ||
| 1066F | 2060F | 3455F |
| A4561 | A4562 | E2001 |
| J0208 | J0612 | J0613 |
| J3380 | J3425 | J7516 |
| J9029 | J9255 | J9260 |
Note: Procedure codes 1066F, 2060F, and 3455F will be effective for dates of service on or after January 1, 2024.
First Quarter 2024 HCPCS Informational Procedure Codes
The following procedure codes will be added as informational only:
| Procedure Codes | ||
| 0439U | 0440U | 0441U |
| 0442U | 0443U | 0444U |
| 0445U | 0446U | 0447U |
| 0448U | 0449U |
Next step for providers: Providers should share this communication with their staff.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
